An abused minority: the mentally ill

I recently read Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness by science journalist Robert Whitaker, which described the abuse of psychiatric drugs by the psychiatric profession and the pharmaceutical industry in the last decades of the 20th century.

That book was so well-documented, so well-written and so shocking that I went back to read Whitaker’s 2003 book, Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill. In this book, Whitaker showed that the abuse of the mentally ill has a long history.

He told how the insane in the 18th and 19th centuries were routinely “spun” until they grew so weak and dizzy they couldn’t move, how they were subjected to removal of teeth, ovaries and intestines, and how they were submerged in water or chilled to the point of hypothermia. Some were exhibited in madhouses as subhuman freaks. None of these supposed treatments were of any benefit to the patient. They merely made mentally ill people more passive and less troublesome.

The exception was “moral treatment” originated by Quakers in York, England. This consisted of good food, regular exercise, an orderly routine and kind treatment. Most of the mentally ill who received moral treatment recovered, and the Quakers treated those who did not as brothers and sisters who were worthy of kindness and help. Philadelphia Quakers adopted the same system with good success.

Ironically this was undermined by the humanitarian reformer Dorothea Dix. She campaigned for state governments to set up mental institutions along Quaker lines. They did, but the underfunded state mental institutions over time became warehouses in which the mentally ill, the mentally retarded, the senile elderly, alcoholics and syphilitics were thrown in together without much treatment for any of them.

Moral treatment was not considered scientific; eugenics was, and it shaped psychiatry during the 20th century, Whitaker said. I had know generally what eugenics was and why it was bad, but I had not known how widespread and enduring it was. The mentally ill were classified among those who were unfit to reproduce. From there, as Whitaker said, it is a short step to defining them, as the Nazis tried to do, as unfit to live.

Since being mentally ill defined you as being at the nadir of human existence, then anything that could be done to remove the mental illness was, by definition, justified. Mental patients were subjected to lobotomies, insulin shock and electroshock, whose “cure” consisted in making them passive and obedient.

The next wave of reform of mental institutions came from Quaker and Mennonite conscientious objectors who did alternative service during World War Two in mental institutions. Appalled at the conditions they found, they sought something better. This led initially to improvement of conditions in mental institutions, but in the long run to the widespread use of psychiatric drugs as a substitute for institutional care.

Starting in the 1950s, patients were subjected to new drugs which, like shock therapies and lobotomies, worked by damaging the brain. As the harmful side effects of each generation of drugs came to be known, the pharmaceutical industry kept coming out with new drugs which, in many cases, deepened the patients’ suffering, created addictions and impaired hope of recovery.

I wouldn’t say, and I don’t think that Whitaker would say, that psychiatric drugs should never be used. Like most Americans, I know people who need medications in order to be able to function. What I would say, and I think Whitaker would say, is that mental illnesses such as schizophrenia are poorly understood, and psychiatrists should exercise humility in presuming to prescribe. Psychiatric drugs are less like insulin for diabetics than they are like mastectomies, hysterectomies, radical prostate surgery or brain surgery, a drastic intervention to be made only when there is no alternative.

Whitaker cited a 1979 study by the World Health Organization, which showed that recovery rates for schizophrenia were much higher in India, Nigeria and Colombia, disparate countries in which the use of psychiatric drugs is rare, than in the United States, England, Denmark, Ireland, Soviet Russia, Czechoslovakia and Japan, where it was common.

Soviet Russia was the heaviest user of psychiatric drugs, and had the worst outcomes. The Soviet Union abused psychiatry in order to suppress dissent, and many of the techniques used to punish dissidents were also used on regular mental patients in both the USSR and USA.

Whitaker cited the relative success of contemporary versions of moral treatment, and how the psychiatric establishment and drug companies don’t want to hear about them, and how drug companies in the 1980s and 1990s tampered with the studies that supposedly proved the effectiveness of the newest generation of drugs.

I once thought the traditional schools of psychology had been discredited, because there was no scientific proof that any of them produces better results than any other, or better results than counseling by minister, priest, rabbi or trusted older relative or friend. But all these things can be of benefit, and none of them involves brain damage.

Click on Mad in America for more information on Robert Whitaker’s home page.